Fractures around the knee and elbow can be difficult to treat due to the limited soft tissue coverage and small size of bone fragments. For example, fractures of the olecranon and patella involve articular surfaces that are treated through anatomic alignment of the joint surface.
These periarticular fractures are traditionally fixed with screw and tension band wiring constructs. The constructs attempt to create a compressive force across the fracture site. For example, in the case of a patella fracture the fragments are loaded in distraction during joint flexion from the pull of the quadriceps and patellar tendons. Accordingly, when affixed with a tension band technique the deep articular surface is loaded in longitudinal compression by the reactive forces across the articular surface and the superficial bone surface is loaded in tension by the pull of a strong muscular insertion such as the quadriceps tendon. As a result, the patella will have a compressive side and a tension side.
A known method of fixation of periarticular fractures includes a technique typically referred to as FIG. 8 tension band wiring. This technique involves driving two stiff stainless steel pins (or screws) longitudinally into bone across the fracture site. A flexible wire is then passed through a drill hole on one side of the fracture site and the two ends of the wire are crossed over the fracture site to the opposite side. One wire is then passed under the ends of the two pins, and the wire twisted and tightened at the other end to develop tension in the wire to produce compression across the fracture site.
The tension band technique holds the tension side of the bone in apposition. This technique results in production of compressive force across the fracture site, resulting in secure fixation, and intended to promote early union of the fracture and early motion of the joint.
At least one shortcoming of the FIG. 8 tension band wiring occurs because standard large pins are used which protrude from the end of the bone at the location where a major tendon inserts. Accordingly, the ends of the pins cause irritation of the soft tissues and require removal. In addition, the tension band wiring can also be uncomfortable as slack in the wire is evident when the joint is extended. The fixation can also be tenuous as advocating early motion can be deleterious to the outcome as the hardware may fail.
Although some improvements to the treatment of periarticular fractures have been developed, there is a need for an improved fixation and neutralization plate.